Surgical kit with multiple planar recess surfaces

ABSTRACT

A surgical kit, for example a percutaneous endoscopic gastrostomy kit, includes a tray having a plurality of recesses formed therein for receiving surgical implements. A substantially rigid accessory item container is received in a container recess defined in the tray. The container is removable from the tray and includes a base member and a lid. A securing device may be configured between the base member and the lid so that the container is reclosable.

BACKGROUND

The present invention relates to pre-packaged surgical kits in general,and more particularly to surgical kits for percutaneous endoscopicprocedures.

Various medical procedures are simplified by providing the physicianwith a kit that contains the majority, if not all, of the necessarymedical articles that the physician will need to complete a particularprocedure. Kits may include articles such as, for example, drapes,syringes, scalpels, needles, clamps, gauze, sponges, drugs, sutures, anddevices. Such kits are commonly provided for procedures such as, forexample, percutaneous endoscopic gastrostomy (“PEG”) and laparoscopicjejunostomy. These kits reduce the time spent by hospital personnelgathering the appropriate articles that are required for a particularprocedure and ensure that the surgeon has each article at hand at theappropriate point in the procedure.

While many current surgical kits include the necessary medicalimplements or articles to complete a particular procedure, the articlesin such kits may not be arranged in the most effective and efficientmanner within the kits.

Also, conventional kits provide not only the surgical implements, suchas scalpels, needles, scissors, and the like, but also “accessory” itemssuch as swabs, gauze pads, single-use packages of ointments andlubricants, suture strands, sponges, and the like. These relativelysmall, loose, items are, however, relatively difficult to store in thekits. Such items may be simply placed loosely in the kit or provided ina sealed pouch. Once the kits or pouches are opened, these items tend toclutter the kit or are moved out of the kit to various locations by thesurgical staff. It is difficult to maintain accountability of the items.Also, the accessory items are generally single-use disposable items andconventional kits do not provide a means for accountability and disposalof the devices after use.

SUMMARY

Objects and advantages of the invention will be set forth in part in thefollowing description, or may be obvious from the description, or may belearned through practice of the invention.

The present invention provides a surgical kit of the type wherein thecontents of the kit include surgical articles and accessory items to beused in performing a particular type of surgery. An example of such akit is a percutaneous endoscopic gastrostomy (PEG) kit. It should beappreciated, however, that kits according to the present invention arenot limited to any particular set of contents or any particular surgicalprocedure. The teachings of the present invention are beneficial for anypre-packaged surgical kit.

An embodiment of a surgical kit according to the invention includes atray having a plurality of recesses formed therein for receivingsurgical articles or implements useful in performing a particularsurgical procedure. The terms surgical “articles” or “implements” areintended to encompass any combination of devices used in a surgicalprocedure and may include, without limitation, scissors, clamps,forceps, medicines and drugs, syringes, needles, tubes, scalpels,snares, cannulas, and so forth. Particular types of procedures requirespecific surgical articles, as is well understood by those skilled inthe art. For example, a PEG kit may also include a “push” or “pull”assembly, a bolus adapter assembly, locking ring, snare device, etc.

The kit may also include any combination of “accessory” surgical items.The term “accessory” item is meant to encompass generally looseancillary articles such as any number of pre-packaged single-usedisposable items. Such items may include, for example, sutures, swabs,ointment packages, lubricant packages, drapes, gauze pads, small vialsor packages of drugs, and the like. In this regard, the kit according tothe invention may include an accessory item container received in acontainer recess defined in the tray. The accessory items may be placedin a separate container which is then placed in the tray prior tosealing the tray. The container may be seated in a respective recessdefined in the tray.

The tray generally includes a cover that is sealed thereto, for exampleby an adhesive around a peripheral edge of the tray. In order to gainaccess to the contents of the tray, the cover is peeled or removed fromthe tray.

The tray includes a plurality of planar surfaces formed therein. Theplurality of recesses are defined in the planar surfaces. The planarsurfaces are offset vertically such that each planar surface is offsetwith respect to at least one other planar surface. In this manner,unobstructed access to certain of the recesses in at least one of thelower planar surfaces is obtained by removing articles from recesses inat least one upper planar surface. In particular embodiments, a firstplanar surface, a second planar surface and a third planar surface maybe provided in the tray. The second planar surface may be offset fromthe first planar surface. The third planar surface may be offset fromthe first planar surface.

A particular embodiment of a surgical kit according to the invention isa PEG kit wherein each recess is adapted to hold an article that isuseful in performing a percutaneous endoscopic gastrostomy. At least oneof the recesses may be adapted to retain at least a portion of apercutaneous endoscopic gastrostomy tube. In some embodiments, such arecess may be disposed on the second planar surface. A retrieval snareand/or a guide wire may be positioned over at least a portion of thepercutaneous endoscopic gastrostomy tube. One of the recesses may beadapted to retain a looped placement wire. In particular embodiments,such a recess may be disposed on the first surface. One of the recessesmay be adapted to retain an exterior tube retention device, and such arecess may be disposed on the second planar surface in some embodiments.Another of the recesses may be adapted to retain an introducer cannula,and such a recess may be disposed in the third planar surface.

Some of the planar surfaces may have one or more bosses extendingupwardly therefrom. In some embodiments, at least one boss may extendupwardly from the second planar surface. At least one boss may bedisposed upon the first planar surface. An article may be positioned sothat at least a portion of such an article is disposed about a boss.

The invention will be explained below in further detail by way ofreference to an embodiment of the invention illustrated in the figures.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a perspective component view of an embodiment of a surgicalkit according to the present invention.

FIG. 2 is a top plan view of the embodiment shown in FIG. 1 with thearticles placed in their respective recesses.

FIG. 3 is a perspective component view of an embodiment of the containeraccording to the invention having been removed from the tray.

FIG. 4 is a perspective view of an embodiment of a tray and storedarticles, including the container.

FIG. 5 is a perspective view of the tray according to FIG. 4 without thearticles contained therein.

FIG. 6 is a top plan view of the tray according to FIG. 5.

FIG. 7 is a side view of the tray according to FIG. 5.

FIG. 8 is an end view of the tray according to FIG. 5.

DETAILED DESCRIPTION

Reference will now be made in detail to embodiments of the invention,one or more examples of which are illustrated in the figures. Theembodiments are provided by way of explanation of the invention, and notmeant as a limitation of the invention. For example, featuresillustrated or described as part of one embodiment may be used withanother embodiment to yield still a different embodiment. It is intendedthat the invention include these and other modifications as come withinthe scope and spirit of the invention.

An embodiment of a surgical kit is illustrated in the figures as apercutaneous endoscopic gastrostomy (“PEG”) kit 20. It should beunderstood that a PEG kit is illustrated and described herein as merelyrepresentative of an embodiment of a surgical kit according to theinvention, and that the invention is not limited to a PEG kit or anyother particular type of kit. A PEG procedure is utilized to place afeeding tube into a patient that extends from the interior of thepatient's stomach exteriorly of the patient. The feeding tube permitsnutrients to be placed directly into a patient's stomach. This may benecessary when a patient has a disorder of the gastrointestinal tract,malabsorption (impaired absorption of nutrients, vitamins or mineralsfrom the diet by the lining of the small intestine), or neurological orrenal disorders. The feeding tube inserted using a PEG procedure is keptin place until a stoma is formed. Once a stoma is formed, a patient mayremove and replace the PEG feeding tube with an alternate feedingdevice.

The PEG kit 20 may include a tray 22 having a plurality of planarsurfaces and a plurality of recesses that may be disposed within theplanar surfaces. The tray 22 may be formed of any suitable material, forexample the tray 22 may be molded from a transparent or translucentsubstantially rigid plastic material (i.e., PETG). The tray 22 may haveside walls 23 defining a depth of the tray 22.

As described in more detail below, the planar surfaces may be verticallyoffset within the tray 22. For example, referring to FIGS. 1, 5, and 6,a plurality of substantially horizontal planar surfaces 64, 66, 68, and70 are defined in the tray 22. The planar surfaces may be co-molded withthe tray 22. Each of the planar surfaces is vertically offset within thetray 22 with respect to at least one other planar surface.

A plurality of recesses adapted to hold articles or implements that areuseful in performing the intended surgical procedure are defined in thevarious planar surfaces 64, 66, 68, and 70. Each recess may be adaptedto hold one or more articles. Examples of recess configurations andrespective articles held therein are discussed in greater detail below.The recesses may also include detents, protrusions, or the like tofrictionally engage and retain the articles within the respectiverecesses.

As seen in FIG. 1, a cover 26 may be positioned on the tray 22 and, insome embodiments, may be adhered to a relatively flat peripheral surface28 of the tray 22. A corner 30 of the tray 22 may be configured so thatthe cover 26 is not adhered to the corner 30. In such an embodiment, auser may grasp the cover 26 that is positioned adjacent to the corner 30to remove the cover 26 from the tray 22. The cover may be attached tothe tray by any suitable method, including but not limited to adhesives,heat sealing, sonic or thermal welding, solvents, etc. Once all of thearticles have been placed into the tray 22 and the cover sealed to thetray, the kit is subjected to ETO gas sterilization.

A suitable cover material is Tyvek™, a spunbond polyolefin, from DuPontof Wilmington, Del. Any number of other permeable web materials suitablefor ETO (ethylene oxide) gas sterilization, such as Kraft paper, may beused as the cover 26.

As illustrated generally in the figures, a container 24 is provided withthe kit 20. The container is desirably a substantially rigid structureadapted to fit at least partially within the tray 22. For example, thecontainer 24 may rest upon the planar surface 64. Desirably, thecontainer 24 is disposed generally at the top of the tray so that accessis provided to the container 24 immediately upon removing the cover 26from the tray 22. In this way, the container 24 can be the first itemremoved from the tray 22 without touching or displacing any of the otherarticles in the tray 22. The tray side walls 23 and a bumper wall 126define a recess or nesting place for the container and engage or retainthe container 24 in a precise location within the tray 22. In oneembodiment, the container 24 may be press-fitted into the nesting place.In another embodiment, the container 24 may be loosely received into thenesting place.

FIG. 3 illustrates an embodiment of a container 24 that may be used inthe present invention. The container 24 may include a substantiallyrigid lid 34 and a base 36, the lid 24 and the base 36 being flexiblyattached to each other by a hinge 38 (i.e., a living hinge). In someembodiments, the lid 34 and the base 36 may not be attached to eachother, or may be attached to each other using alternate configurations.The container may be molded or otherwise formed from the same polymermaterial as the tray 22. A lip 40 may be provided that extends aroundthe edges of the lid 34 and the base 36. In particular embodiments, anextended portion 42 may be disposed along one edge of the lip 40 toenable a user to more easily open the container 24. One or both of thelips 40 may include a number of bosses 41 extending therefrom. Thesebosses 41 keep the opposing lips 40 spaced apart in a closed state ofthe container so that the ETO (ethylene oxide) sterilization gas canreadily permeate into the container.

The container 24 is desirably configured to be reclosable. In thismanner, the container 24 provides a convenient device for storing usedarticles prior to disposal. The container 24 may be variously configuredso that it is reclosable by, for example, providing a pair of bosses 44disposed on the lid 34 that mate to a pair of detents 46 that aredisposed on the base 36. Other mechanisms that may be useful to reclosethe container 24 include but are not limited to adhesives, hook-and-loopfasteners, locking arms, and the like.

Embossing, such as embossing 52 in FIG. 3, may be disposed on the outersurface 48 of the lid 34 or on the outer surface 50 of the base 36.Alphanumeric, numeric or other characters may be embossed on thecontainer 24.

The tray 22 and container 24 are illustrated as generally rectangular inthe figures. However, it should be appreciated that these components maytake on any convenient shape.

Referring to FIG. 3, the container 24 may be adapted to hold a varietyof accessory medical articles including, for example, suture strands(packaged) 112A, swabs (i.e., povidone-iodine prep swabsticks) 124A,lidocaine insert 122A, fenestrated gauze pads 108A, gauze pads 108B,fenestrated drape 129A, single-use packages of lubricant 130A,single-use packages of ointment 124B (i.e., povidone-iodine ointment),antibiotic ointment 128A, sponges, and the like. As described, thecontainer is particularly well suited for retaining these devices afterthey have been used for later disposal.

As shown in the Figures in general, the tray 22 may include a firstplanar surface 64. Several recesses are disposed in surface 64,including two recesses 76 that may be used to hold or support coiledarticles and a needle recess 81. The recesses 76 can be seenparticularly in FIGS. 5 and 6 and may be, for example, generallycircumferentially extending recesses that extend around at least aportion of a generally circular structure that defines planar surface68, as described in greater detail below. The needle recess 81 mayinclude two elongated recesses 80 and 82 so that the needle recess 81may hold two needles securely. In selected embodiments, recess 80 may beconfigured to hold a filter needle 80A and the recess 82 may beconfigured to hold a needle 82A. A recess 90 may be disposed in thefirst surface 64 and may be configured to hold a looped placement wire90A for “pull” type PEG procedures. In some embodiments, the loopedplacement wire 90A may be coiled around a spool and the recess 90 may berounded to easily accept and hold the looped placement wire 90A.

The first surface 64 may also include a recess 103 that may beconfigured to have elongated portions 104 and 105. A pair of surgicalscissors 104A may be disposed in the portion 104 of the recess 103, anda hemostat 105A may be disposed in the portion 105 of the recess 103.

The first surface 64 may also include a recess 115 that may be elongatedand have two spaced apart ends 114 and 116. As shown in FIGS. 1 and 2, abolus feeding adapter 114A may be at least partially disposed in the end114 of the recess 115. A universal feeding adapter 116A may also be atleast partially disposed in the end 116 of the recess 115.

The first planar surface in the illustrated embodiment also defines anesting place for the container 24. An elongated boss 126 may bedisposed on the first planar surface 64 for this purpose. This boss 126and two of the tray side walls 23 cooperate to define a recess orstorage location for the container 24 on the first planar surface 64.The container 24 actually rests on the surface 64 above a number of thearticle recesses. For example, referring to FIGS. 1, 5, and 6 therecesses 80, 81, 82, 90, 103, 104, and 105, as well as their associatedarticles, are all disposed under the container 24. The physician mustfirst remove the container 24 to gain access to these recesses.

As seen in FIGS. 4-6, a second planar surface 66 may also be providedand may, in selected embodiments, be offset from the first planarsurface 64. Numerous recesses may be disposed in the second planarsurface 66 including a recess 78 that is adapted to hold a container oflidocaine 78A and a recess 84 that may be adapted to hold a scalpel 84A,as shown in FIG. 4.

A recess 110 may also be provided in the second planar surface 66, therecess 110 being adapted to hold an exterior tube retention device 110A.In some embodiments, a SECUR-LOK™ ring, available from Ballard MedicalProducts in Draper, Utah, may be used as an exterior tube retentiondevice 110A. A boss 132 may be disposed in the recess 110 to support theexterior tube retention device 110A.

The second planar surface 66 may also include a recess 94 that isadapted to hold at least a portion of a percutaneous endoscopicgastrostomy (PEG) tube 94A, as seen in FIG. 1. Such a PEG tube typicallyincludes an internal retention device such as a bumper 98A and anelongated tube 96A. For a “pull” type PEG procedure, a loop is providedat the end of the tube 96A. For a “push” type of PEG procedure, anelongated tapered tip 100A is provided at the end of the tube 96A. Therecess 94 may include a rounded portion 98 that will hold the bumper98A. The recess 94 may also include an elongated portion 96 that willhold at least a portion of the elongated tube 96A. The portion of theelongated tube 96A that is not disposed in the elongated portion 96 ofthe recess 94 may be coiled and placed within the recesses 76 that areformed in the first planar surface 64. In such an embodiment, a portionof the coiled elongated tube 96A may rest on the portions of the firstplanar surface 64 that are disposed between the recesses 76.

One or more bosses 92 may be disposed on the second planar surfaceproximate to the recess 94, one boss 92 being disposed on one side ofthe recess 94 and another boss 92 being disposed on the other side ofthe recess 94. In such an embodiment, a retrieval snare 92A, as seen inFIG. 4, may be positioned on the second planar surface so that thehandle 91A of the retrieval snare 92A is secured in place by the bosses92. In such an embodiment, at least a portion of the retrieval snare 92Ais positioned over the PEG tube 94A, the bumper 98A being disposed underthe handle 91A of the retrieval snare 92A. The coiled end 93A of theretrieval snare 92A may be disposed over a portion of the coiled tube96A of the PEG tube 94A so that both coils 93A and 96A supported by thefirst planar surface 64 and may be at least partially disposed in therecesses 76.

For “push” type PEG procedures, a coiled sheathed guide wire 106A may beprovided in the kit, as seen in FIGS. 1, 2, and 6. The guide wire 106Amay be placed in the recess 76 on top of the coiled end of the snare 93Aand coiled tube 96A of the PEG tube 94A.

A third planar surface 68 may also be provided in the tray 22. The thirdplanar surface may be offset from the first planar surface 64, from thesecond planar surface 66, or from both the first and second planarsurfaces 64 and 66, respectively. In the embodiment depicted in theFigures, the third planar surface 68 may be disposed within the interiorof the coils 93A and 96A. A recess 120 may be formed in the third planarsurface as shown in FIG. 9. The recess 120 may be configured to hold oneor two twelve-ounce syringes 120A. A recess 118 may also be disposed inthe third planar surface 68 and may be adapted to hold a tubing clamp118A. The planar surfaces 64, 66, and 68 may all be at least partiallyoutside of the perimeter defined by one another in accordance with oneor more exemplary embodiments of the present invention.

A fourth planar surface 70 may be disposed adjacent to the third planarsurface 68, as seen in FIGS. 4 and 5. A recess 86 that is adapted tohold an introducer cannula 86A may be formed in the third and fourthplanar surfaces 68 and 70, respectively.

In selected embodiments and as shown in FIG. 5, a fifth planar surface72 may be provided that is adjacent to the fourth planar surface 70. Thefifth planar surface 72 may be configured to provide additional supportto the coils 93A and 96A.

The tray 22 may also be configured to hold a pamphlet (not shown) thatmay contain various information such as, for example, directions forusing the PEG kit 20.

From the foregoing description, it should be appreciated that thearrangement of the vertically offset planar surfaces and theirrespective article recesses results in an arrangement wherein certain ofthe articles must be removed from the kit before unobstructed access isprovided to certain underlying articles. The articles are arranged sothat, desirably, such articles can be readily removed from the tray intheir order of use. For example, in the embodiment illustrated in theFigures wherein the surgical kit is a PEG kit, the container 24 containsmany of accessory items needed to prep the surgical site on the patient.The container is seated in its recess on the first planar surface 64 andis readily removable upon removing the cover 26 from the tray 22. Thesnare device 92A within recess 92 is used before the PEG tube 94A withinrecess 94, and the snare device 92A must be removed before the PEG tube94A can be removed. The feeding adapters 114A and 116A within respectiverecesses 114 and 116 are used towards the end of a PEG procedure andaccess to the adapters is provided after removal of the snare 92A andPEG tube 94A.

The invention may be embodied in other specific forms without departingfrom the scope and spirit of the inventive characteristics thereof. Thepresent embodiments therefore are to be considered in all respects asillustrative and not restrictive, the scope of the invention beingindicated by the appended claims rather than by the foregoingdescription, and all changes which come within the meaning and range ofequivalency of the claims are therefore intended to be embraced therein.

1. A surgical kit, comprising: an integral tray; a plurality of surgicalarticles comprising a first, second and third surgical article; a firstplanar surface defined within the tray and defining a first planarsurface recess disposed therein, said first surgical article beingdisposed in the first planar surface recess; a second planar surfacedefined within the tray and defining a second planar surface recessdisposed therein, said second surgical article being disposed in thesecond planar surface recess, the second planar surface being verticallyoffset from the first planar surface; and a third planar surface definedwithin the tray and defining a third planar surface recess disposedtherein, said third surgical article being disposed in the third elanarsurface recess, the third planar surface being vertically offset fromthe first planar surface and the second planar surface; and wherein saidfirst, second, and third planar surfaces are all at least partiallyoutside of the perimeter defined by one another, and wherein said firstand second planar surface recesses are positioned within said tray andsaid first and second surgical articles are disposed in said tray suchthat the second surgical article must be removed from said tray prior toaccess being provided to the first surgical article, said first, secondand third surgical articles correspondingly arranged in said tray suchthat unobstructed access is provided to said first, second and thirdsurgical articles in their order of use for a particular surgicalprocedure.
 2. A surgical kit, comprising: an integral tray; a firstplanar surface defined within the tray and defining a first planarsurface recess disposed therein, a first surgical article disposed inthe first planar surface recess; a second planar surface defined withinthe tray and defining a second planar surface recess disposed therein, asecond surgical article disposed in the second planar surface recess,the second planar surface being vertically offset from the first planarsurface; and a third planar surface defined within the tray and defininga third planar surface recess disposed therein, a third surgical articledisposed in the third planar surface recess, the third planar surfacebeing vertically offset from the first planar surface and the secondplanar surface; and wherein the second planar surface is at leastpartially outside of the perimeter defined by the first planar surface,and wherein said first and second planar surface recesses are positionedwithin said tray and said first and second surgical articles aredisposed in said tray such that the second surgical article must beremoved from said tray prior to access being provided to the firstsurgical article, said first and second articles correspondinglyarranged in said tray such that unobstructed access is provided to saidfirst and second articles in their order of use for a particularsurgical procedure; and a removable container adapted to fit at leastpartially within said tray, said container adapted to rest upon at leasta portion of said first planar surface while providing access to atleast one said recess defined in said first planar surface, saidcontainer being reclosable and containing at least one accessory articleuseful in performing the surgical procedure.
 3. The surgical kit as inclaim 2, further comprising a plurality of said recesses defined in saidfirst planar surface below said container such that said container mustbe removed from said tray prior to having access to articles containedin said recesses below said tray.
 4. The surgical kit as in claim 1,further comprising a cover adapted to be placed over said tray.
 5. Thesurgical kit as in claim 1, further comprising at least one bossextending upwardly from at least one of said planar surfaces, said bossconfigured for extending through at least a portion of a surgicalarticle.
 6. The surgical kit as in claim 5, wherein said boss extendsthrough a handle portion of a snare device.
 7. A surgical kit,comprising: a tray comprising a plurality of planar surfaces definedtherein; a plurality of article recesses defined in said planar surfacessuch that at least one said recess is defined in each of said planarsurfaces, each said recess having a shape for receipt of a particularsurgical article therein; and wherein said planar surfaces are arrangedsuch that each said planar surface is offset vertically with respect toat least one other said planar surface and said recesses positionedwithin said tray such that articles in at least one upper said planarsurface must be removed from said tray prior to access being provided toarticles in at least one lower said planar surface, said articlescorrespondingly arranged in said tray such that unobstructed access isprovided to said articles in their order of use for a particularsurgical procedure; further comprising at least one boss extendingupwardly from at least one of said planar surfaces, said boss configuredfor extending through at least a portion of a surgical article; whereinsaid boss extends through a handle portion of a snare device; andwherein said snare device overlies at least a portion of another saidarticle received in a recess defined below the position of said snaredevice.
 8. The surgical kit as in claim 7, wherein said article in saidrecess below said snare device comprises a percutaneous gastrostomytube.
 9. The surgical kit as in claim 8, further comprising a coiledguide wire overlying a portion of said percutaneous gastrostomy tube.10. A percutaneous endoscopic gastrostomy (PEG) kit comprising: a tray,said tray further comprising a first planar surface comprising at leastone recess disposed within the first planar surface, a second planarsurface comprising at least one recess disposed within the second planarsurface, the second planar surface being offset from the first planarsurface, a third planar surface comprising at least one recess disposedwithin the third planar surface, the third planar surface being offsetfrom the first planar surfaces a container at least partially fittingwithin the tray, the container resting upon at least one of theplurality of planar surfaces while leaving at least one said recess insaid planar surface exposed, wherein the planar surface onto which thecontainer rests is at least partially outside of the perimeter definedby at least two of the other planar surfaces of the tray, the containeradapted to be reclosable and to retain accessory articles useful inperforming a medical procedure; and a cover adapted to be placed overthe tray; wherein each recess is adapted to hold at least one articleuseful in performing a medical procedure.
 11. The PEG kit as in claim10, wherein at least one said recess disposed in said first planarsurface is adapted hold a looped placement wire.
 12. The PEG kit as inclaim 10, wherein at least one said recess disposed in said secondplanar surface is adapted to hold at least a portion of a percutaneousendoscopic gastrostomy tube.
 13. The PEG kit as in claim 12, whereinsaid percutaneous endoscopic gastrostomy tube comprises a bumper, saidbumper disposed within at least one said recess in said second planarsurface.
 14. The PEG kit as in claim 10, wherein at least one saidrecess disposed in said third planar surface is adapted to hold anintroducer cannula.
 15. The PEG kit as in claim 10, wherein said coverrests on a peripheral edge of said tray.
 16. The PEG kit as in claim 10,wherein at least one said recess disposed in said first planar surfaceis adapted to retain at least a portion of a guide wire.
 17. The PEG kitas in claim 10, wherein at least one said recess disposed in said secondplanar surface is adapted to retain an exterior tube retention device.18. The PEG kit as in claim 10, wherein said container rests on at leasta portion of said first planar surface.
 19. A percutaneous endoscopicgastrostomy (PEG) kit comprising: a tray, said tray further comprising afirst planar surface comprising at least one recess disposed within thefirst planar surface, a second planar surface comprising at least onerecess disposed within the second planar surface, the second planarsurface being offset from the first planar surface, a third planarsurface comprising at least one recess disposed within the third planarsurface, the third planar surface being offset from the first planarsurface a container at least partially within the tray, the containerresting upon the first planar surface while leaving at least one saidrecess in said first planar surface exposed, the container adapted to bereclosable and to retain accessory articles useful in performing amedical procedure; and a cover adapted to be placed over the tray;wherein each recess is adapted to hold at least one article useful inperforming a medical procedure; wherein at least one of said planarsurfaces comprises at least one boss extending upwardly from thesurface.
 20. The PEG kit as in claim 19, wherein said boss extendsupwardly from said second planar surface.